January 03, 2006

Missing the Freaking Point

Not all ventilators are created equal and that's the point that Steven E. Landsburg fails to understand in his otherwise on target fisking of Yucutan man's generally idiotic tear jerker post blaming George W Bush for a terminally ill cancer patient's ventilator support withdrawal.

Let's face facts. Not every poor person gets the charity care that we'd wish they had. There isn't enough money to provide 1st class medical care equivalent to what a member of Congress or a corporate titan gets. There just isn't enough money even in the most liberal of fantasy budgets.

So when you have X ventilator bed days available in your charity care budget, who do you give it to? Do you give two weeks of ICU to the poor guy who got caught in a building fire and has smoke inhallation and serious burns allowing him to recover and go back to supporting his family or do you give two more weeks to the terminal cancer patient who is waiting for her mom so that she can have her plug pulled and die in her mother's arms?

Did her brother offer a spare room and rent a ventilator for $80 a day? Let's say they did an ambulance transport (~$500), bought a hospital bed (~$700), and got somebody from the neighborhood to stay with her (~$700/wk). If mom took two extra weeks we're talking about under $4000 in expenses here. Her family could have raised that. Her family could have financed that. They didn't care enough to set back their own financial plans. (In reality, you'd shop for a cheaper bed or rent it and you'd pay more for skilled nursing visits but I can't find the appropriate numbers).

Hospital beds are an expensive way to wait to die. ICU beds are ~$1800 a day. That's the hospital overhead with all that equipment, all that specialized training waiting to resuscitate you at the drop of a hat. A two week wait for mom to show up would have pulled ~$25,000 from that hospital's charity care budget.

Tirhas Habtegiris' family decided that if society wasn't willing to pay ~$25k, they weren't personally willing to pay ~$4k and spend the time and effort to keep Tirhas alive. The reality is that Tirhas was failed. But it was her family that failed her. Her touching wish didn't merit her family's consideration. Why should society have granted her wish at 6 times the cost? And if her mom would have taken more than two weeks to arrive, the cost differential would have widened, not narrowed.

Providing charity care is something that a decent society does. You can do it publicly, privately, or using a mix of the two systems. It's always rationed though and the bottom of the list for that sort of care is, and should be, very expensive care for the terminally ill that has no medical benefit. The hospital, no doubt, would have been willing to move her home, helped out with providing a ventilator, maybe even educated a family member how to tend to the machine so Tirhas could have her wish. All that could have been done for less net expense. Hospitals are willing to do all sorts of unorthodox things if they're asked. Instead, Tirhas stayed in ICU and she died of it.

It's a real shame.

I'm speaking as someone who has gone through the process, including paying the bills afterwards (in my case the relative lived and continues to live). This sad story could have ended differently. The system provided a way out. The family either didn't choose to take it or the hospital didn't educate them that there was an alternative. Either way, the fault is not George W Bush's.

Posted by TMLutas at January 3, 2006 09:55 AM